LAND USE Initial Application Date: // - / _ /I9 Application # / r aja 2 5 - 5 - 4U •
DRB CU
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting / 108 E. Front Street, Lillington, NC 27548 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.hamett.org /permits
LANDOWNER: ,/ rA4/Q e Mailing Address:
City: road
/,/ /iui State: Zip: Home #: Pa 747... Contact #:
APPLICANT*: � / /A • 1 0-/•i - 3 ( .chip an ,t Mailing Address: 9o0 Z ad
t city: (.:Lt.-Ake a State: Arc Zip: 28210 _Office It 9 /9- nit setao Contact #: WT sea - 8(95
'Please fill out applicant Information it different than landowner do
CONTACT NAME APPLYING IN OFFICE: !.f• 6.5 5;4#01.-- Phone #: WI. 4Ro • efts
PROPERTY LOCATION: Subdivision: � Lot #: - Lot Size: a lL
State Road #: LL Slate Road �a
d Name: / Map Book &Page: Z'� / 717_
_
Parcel: t/,/ 96 2 3 Oa/ ! U3 ,, // PIN: , 4 34 — , //" 0- ZJ�Z- 00f
Zoning:A/ L GTr Flood Zone: Watershed: /(//l- 7Z ! Deed Book &Page: ZS �7l / / N ZPower Company':
New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINOTON: K' ZIv /0 j/4/ R,41 Rood • --,7,4 e
le-ii. g/ /or...) rnad Lt •• s 4�aa Govt Turn A'T, /o ercr+flr a.
.
Jell 3 lt/ in nob lbrI &rs (.tpOQrnde, ,Srk.
PROPOSED USE:
❑ Multi - Family Dwelling No. Units No. Bedrooms/Unit
Cl Business Sq. Ft. Retail Space Type # Employees: Hours of Operation:
❑ Daycare # Preschoolers # Afterschoolers # Employees Hours of Operation
❑ Industry Sq. Ft. Type # Employees: Hours of Operation:
❑ Church Seating Capacity # Bathrooms Kitchen
O Accessory/Addition/Other (Size_( _x too ) Use _ Pro/cc/tie a ver ,<r SC•Jr oFt /pack, arca
Water Supply: County (J Well (No. dwellings ) MUST have operable water before final
Sewage Supply: U New Septic Tank (Complete Checklist) (J Existing Septic Tank (Complete Checklist) County Sewer
Comments:
If permits are granted I agree to co l
to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I r : a e t at or: .a '. _ .. e , are accurate and correct to the best of my knowledge. Permit subject to revocation if false information Is provided.
91 ure of Ow Owner's Ag t Date
d / /!t� \/ "This application expires 6 months from the Initial date If no permits have been Issued"
A RECOR SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
LAND USE 5/08